Healthcare Provider Details

I. General information

NPI: 1588878870
Provider Name (Legal Business Name): LIGHTHOUSE FOR THE BLIND OF HOUSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 W DALLAS ST
HOUSTON TX
77019-1704
US

IV. Provider business mailing address

3602 W DALLAS ST
HOUSTON TX
77019-1704
US

V. Phone/Fax

Practice location:
  • Phone: 713-284-8494
  • Fax: 713-284-8468
Mailing address:
  • Phone: 713-284-8494
  • Fax: 713-284-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GIBSON DUTERROIL
Title or Position: PRESIDENT
Credential:
Phone: 713-284-8420